Glow All Out Client Intake Form

Glow All Out Client Intake Form

Please answer all questions truthfully and to the best of your knowledge
Name

First NameLast Name
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
General Spray Tan Information
Have you ever had a spray tan before?
If yes, when was your last spray tan?
Have you ever experienced an allergic reaction or adverse reaction to a spray tan?
If yes, please specify:
Have you ever been diagnosed with an allergy to DHA (Dihydroxyacetone), cosmetic bronzers, fragrances, or skincare products?
If yes, please specify:
Skin Assessment
How would you describe your natural skin tone?
SKIN SENSITIVITY TO SUN EXPOSURE
Which statement best describes how your skin reacts to sun exposure?
Desired Spray Tan Result
What level of color are you hoping to achieve?
Additional Skin Considerations
Do you currently have any of the following?
If yes, please specify:
Areas of Concern
Are there any areas you would likeyour spray tan artist to be aware of?

Other
Appointment Details
What is the occasion for your spray tan?

Other
If yes, please specify:
*Confirm (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment.
Should be Empty:

General Spray Tan Information